Doctors, non-physicians battle over medical turf

SACRAMENTO -- A series of bills to expand the roles of nurse practitioners and other healthcare professionals has set off a turf war with doctors over what non-physicians can and can’t do in medical practices.

Citing a doctor shortage in California, state Sen. Ed Hernandez (D-West Covina) has proposed legislation that would redefine professional boundaries for nurse practitioners, pharmacists and optometrists to help treat what is expected to be a crush of newly insured Californians seeking care next year under the federal healthcare law.

But physicians are pushing back, arguing that the proposed “scope of practice” changes would radically alter longstanding medical standards and jeopardize patient safety.

Under amendments circulating around the Capitol, optometrists would be allowed to diagnose and treat “any disease, condition, or disorder of the visual system, the human eye, and adjacent and related structures.” The California Medical Assn. says that language is so broad that it could apply to cosmetic procedures, such as Botox injections.

Optometrists would also be authorized to perform surgical “primary care” procedures with local anesthetic and diagnose and treat conditions with “ocular manifestations,” which could include diabetes and high blood pressure.

“We want these allied health professionals to be practicing at the top of their training,” said Molly Weedn, a spokeswoman for the CMA, “but this language goes far outside what they are trained to do. It’s just not safe.”

Under another bill, pharmacists would be allowed to independently administer vaccines to children and prescribe smoking cessation and birth-control drugs, after receiving additional training. They could also earn “advanced practice” status, allowing them to perform physicals, order lab tests and prescribe, adjust or discontinue medications.

A separate measure would enable nurse practitioners to set up independent practices, without the supervision of physicians.

The proposed amendments have not been formally introduced, and Hernandez’s office characterized them as a starting point for debate. In a statement, the lawmaker said legislation was critical to alleviate California’s physician shortage as the state braces for millions of newly insured residents.

“A wide range of highly trained healthcare providers are standing by to help safely deliver primary care services that these patients desperately need,” Hernandez said in a statement. “There's no reason these licensed professionals can't perform additional services like they do in other states, which have reported no decline in patient safety whatsoever.”